Accepting Patients Without Judgment

Interview with R. Kevin Mallinson, Ph.D., RN, AACRN
Principal Investigator, Nurses SOAR! [Strengthening Our AIDS Response]
Global HIV/AIDS Nursing Capacity Building program in South Africa, Lesotho, and the Kingdom of Swaziland

If you could speak to all nurses, what would be the best piece of advice you could give them regarding working with HIV/AIDS patients? 

Dr. Mallinson:  In light of the recent trends towards “mainstreaming” patients with HIV/AIDS as if they have a chronic illness akin to diabetes, I would provide words of caution:  having HIV disease is not the same as having an ordinary chronic condition. Nurses need to conduct a thorough and holistic assessment of the patient’s health. Persons with HIV/AIDS often experience ostracism, condemnation, and discrimination when disclosing their HIV status. The psychosocial burden of living with a life-threatening disease – and make no mistake at its capacity for morbidity and mortality – is compounded by grief, anxiety, and uncertainty in addition to social barriers such as poverty, racism, and homophobia. My best advice is to learn how to accept your patients without making judgments and take the time to “listen” to their story. Finally, provide support and validation of their individual experiences as persons living with HIV/AIDS.

What do you think is the most important concept you would like to get across to the general public regarding HIV/AIDS?

Dr. Mallinson:  The most important concept I would communicate is that HIV/AIDS is not a disease of homosexuals, injection drug users, sex workers, and racial minorities. Rather, HIV/AIDS is a disease that affects people in our communities who deserve our love and support:  our uncles, nieces, brothers, neighbors, and co-workers. When we objectify individuals into risk groups, we tend to diminish their humanity and assign shame and blame for their health status. HIV affects men, women, and children around the globe who have no ill intentions; they are simply living their lives in the presence of an infection that is [largely] spread by sexual contact. Consequently, we should endeavor to express our love and understanding to persons with HIV/AIDS and challenge ourselves to learn more about the socio-economic barriers to maintaining healthy lives and effectively using safer sexual behaviors.

What is your greatest barrier to providing quality care to your clients?

Dr. Mallinson:  The greatest barrier to the provision of quality HIV/AIDS care is nurse apathy. Nurses who do not challenge themselves to learn the fundamental concepts of HIV prevention, treatment, and care may inadvertently provide substandard care and ineffective patient and family teaching. I believe that HIV/AIDS remains – largely – a nursing-sensitive pandemic. Nurses have the potential to provide effective prevention interventions, focused treatment and symptom management, and compassionate palliative and end-of-life care. The main challenge is to have them perceive persons with HIV/AIDS as valuable, worthwhile human beings deserving of the best that nursing can offer.

Are there any specific things that you say to HIV/AIDS clients (or family members) to facilitate effective treatment?

Dr. Mallinson:  To facilitate effective treatment, I don’t “say” anything to persons with HIV/AIDS. Rather, I “ask” questions. I probe if they are concerned about their future. I inquire about their fears and anxieties. I assess their quality of life and identify areas for improvement (e.g. gaining weight, reducing fatigue and increasing energy levels, or avoiding hospitalizations). Promoting adherence to treatment is more about achieving goals that the patient wishes to accomplish and less about our ability to provide good “education.” If a woman is able to return to work and still has the energy to play with her two children when she arrives home, she is much more likely to maintain her medication regimen.

What do you enjoy most about your work with HIV/AIDS clients?

Dr. Mallinson:  Working in the HIV/AIDS area demands the best of my nursing education and expertise. I believe that the complex multi-sector, multi-layer aspects of HIV prevention, treatment, and care demand that I apply my knowledge and skills in pathophysiology, psychology, and sociology. I am challenged to understand the impact of policy decisions on the day-to-day lives of clients with HIV/AIDS. Whether my clients are in the southeast neighborhoods of Washington, D.C., or the rural areas of the Kingdom of Swaziland, they continue to be an inspiration to the strength and resilience of the human spirit. After 25 years, I continue to be amazed at the human capacity to face adverse conditions with a sense of self-respect, a commitment to loved ones, and an optimism that life’s worst barriers can be overcome. What I love most [not just enjoy most] about my work with persons with – or at risk for – HIV/AIDS is the extraordinary ability to demonstrate love and caring in the worst of the epidemic. •